Your search found 29 Results

  1. 1

    Medical eligibility criteria for contraceptive use. Fifth edition 2015. Executive summary.

    World Health Organization [WHO]. Department of Reproductive Health and Research

    Geneva, Switzerland, WHO, 2015. [14] p. (WHO/RHR/15.07)

    This executive summary contains all the new recommendations that will be incorporated into the fifth edition of the Medical eligibility criteria for contraceptive use. In addition to the recommendations themselves, the summary provides an introduction to the guideline, a description of the methods used to develop the recommendations for this fifth edition, and a summary of changes (from the fourth edition to the fifth edition of the MEC). It is anticipated that the Medical eligibility criteria for contraceptive use, fifth edition will be available online by 1 July 2015. In the interim, the fourth edition of the guideline, along with this summary of new recommendations provides the complete set of WHO recommendations on medical eligibility criteria for contraceptive use.
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  2. 2

    A guide to family planning for health workers and their clients.

    World Health Organization [WHO]

    [Geneva, Switzerland], WHO, 2010 Mar. [8] p.

    Adapted from the WHO's Decision-Making Tool for Family Planning Clients and Poviders, this flip-chart is a tool to use during family planning counseling or in group sessions with clients. It can: help your clients choose and use the method of family planning that suits them best; give you the information you need for high-quality and effective family planning counselling and care; help you know who may need referral.
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  3. 3

    Family planning based on periodic abstinence. A preliminary glossary (draft).

    World Health Organization [WHO]. Special Programme of Research, Development and Research Training in Human Reproduction. Task Force on Methods for the Determination of the Fertile Period

    [Unpublished] [1978]. 11 p.

    This glossary, prepared by the Task Force on Methods for the Determination of the Fertile Period of the World Health Organization (WHO) Special Program of Research, Development and Research Training in Human Reproduction, defines 79 terms and concepts central to the understanding of family planning based on periodic abstinence. The glossary was the result of awareness that the absence of standardized terminology has resulted in misunderstandings regarding the teaching and practice of natural family planning methods, errors in the overall interpretation of data and evaluation of effectiveness, and communication difficulties between family planning programs and investigators. The glossary is primarily intended to provide technical language for the natural family planning instructor as a tool for communication with couples who intend to practice family planning based on periodic abstinence. Efforts were made to use simple and precise language, and it is expected that the glossary will be translated from English and adapted to local vernacular and cultures. The glossary in not intended to replace a manual of instruction on natural family planning planning.
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  4. 4
    Peer Reviewed

    A prospective multicentre trial of the ovulation method of natural family planning. Pt. 2. The effectiveness phase.

    World Health Organization [WHO]. Special Programme of Research, Development and Research Training in Human Reproduction. Task Force on Methods for the Determination of the Fertile Period

    Fertility and Sterility. 1981 Nov; 36(5):591-98.

    A 5 country prospective study was undertaken to determine the effectiveness of the ovulation method of natural family planning. 869 subjects of proven fertility from 5 centers (Auckland, Bangalore, Dublin, Manila, and San Miguel) entered the teaching phase of 3-6 cycles; 765 (88%) completed the phase. 725 subjects entered a 13-cycle effectiveness phase and contributed 7514 cycles of observation. The overall cumulative net probability of discontinuation for the effectiveness study after 13 cycles was 35.6%, 19.6% due to pregnancy. Pregnancy rates per 100 woman-years calculated using the modified Pearl index were as follows: conscious departure from the rules of the method, 15.4; inaccurate application of instructions, 3.5; method failure, 2.8; inadequate teaching, 0.4; and uncertain, 0.5. Cycle characteristics included: 1) average duration of the fertile period of 9.6 days, 2) mean of 13.5 days occurred from the mucus peak to the end of the cycle, 3) a mean of 15.4 days of abstinence was required, and 4) a mean of 13.1 days of intercourse was permitted. Almost all women were able to identify the fertile period by observing their cervical mucus but pregnancy rates ranged from 27.9 in Australia and 26.9 in Dublin to 12.8 in Manila. Continuation was relatively high ranging from 52% in Auckland to 74% in Bangalore.
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  5. 5

    Survey report: Eastern Caribbean.

    Yinger N

    POPULATION TODAY. 1991 Jul-Aug; 19(7-8):4.

    Over 1 million people live on 8 small islands in the Eastern Caribbean: St. Kitts-Nevis, Montserrat, Grenada, St. Vincent, Antigua, Barbados, St. Lucia, and Dominica. Starting in 1985 the International Planned Parenthood Federation, Western Hemisphere Region has carried out a series of contraceptive prevalence surveys in these countries. Current information is provided by these surveys in the areas of fertility levels and preferences, contraceptive knowledge and use. Also, socioeconomic, historical and demographic background and analysis such as fertility patterns, desire for additional children, and breastfeeding data; contraceptive awareness including family planning methods and sources; contraceptive use by method, source, and timing, satisfaction, and male attitudes are provided in the surveys, but not in the report abstracted here. The total fertility rate (TFR) and the contraceptive prevalence rate (CPR) for the 8 islands are as follows: St. Kitts-Nevis (1984) 2.9 TFR, 40.6 CPR; St. Vincent (1988) 2.9 TFR, 58.3 CPR; Antigua (1988) 1.8 TFR, 52.6 CPR; Barbados (1988) not given, 55.0 CPR; St. Lucia (1988) 3.2 TFR, 47.3 CPR; Dominica (1987) 3.2 TFR, 49.8 CPR. The islands have unusual demographic patterns related to extensive out-migration.
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  6. 6

    Natural family planning: a good option.

    Georgetown University. School of Medicine. Institute for International Studies in Natural Family Planning

    Washington, D.C., Georgetown University, School of Medicine, Institute for International Studies in Natural Family Planning, 1989 Jul. 15, [2] p. (USAID Cooperative Agreement DPE-3040-A-00-5064-00)

    Natural family planning (NFP) is a technique for determining a woman's fertile period to regulate childbearing. There are many methods in NFP including rhythm or calendar, basal body temperature, cervical mucus, modified mucus, and sympto-thermal. All of these methods use the natural signs and symptoms of a woman's fertile and infertile periods of the menstrual cycle. The rhythm or calendar is still the most widely used method, and women keep track of the lengths of previous menstrual cycles to determine the days of fertility. The cervical mucus method uses changes in the characteristics of the mucus during the fertile period. The basal body temperature method uses the change in resting temperature to determine the fertile period. The sympto-thermal method uses a combination of body temperature, cervical mucus, and breast tenderness to determine the fertile period. Breast feeding provides a period of about 6 months after birth when there is a delay in the return of ovulation. The advantages of natural family planning include the following: little contact with medical personnel and procedures, it is less expensive, it may provide a method in agreement with religious or ethical beliefs, and it can help couples understand how their reproductive system works. In a World Health Organization study, the effectiveness of NFP was shown to be 78% overall, and the continuation rate was 65%. Many other studies have shown rates between 70-90% effectiveness over a 12 month period. In a recent African study over a 5 year period, unplanned pregnancy rates were 4.3% and 9.6% in Liberia and Zambia respectively.
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  7. 7

    [The Church, the Family and Responsible Parenthood in Latin America: a Meeting of experts] Iglesia, Familia y Paternidad Responsable en America Latina: Encuentro de Expertos.

    Consejo Episcopal Latinoamericano [CELAM]

    Bogota, Colombia, CELAM, 1977. (Documento CELAM No. 32.)

    This document is the result of a meeting organized by the Department of the Laity of the Latin American Episcopal Council on the theme of the Church, Family, and Responsible Parenthood. 18 Latin American experts in various disciplines were selected on the basis of professional competence and the correctness of their philosophical and theological positions in the eyes of the Catholic Church to study the problem of responsible parenthood in Latin America and to recommend lines of action for a true family ministry in this area. The work consists of 2 major parts: 12 presentations concerning the sociodemographic, philosophical-theological, psychophysiological, and educational aspects of responsible parenthood, and conclusions based on the work and the meetings. The 4 articles on sociodemographic aspects discuss the demographic problem in Latin America, Latin America and the demographic question in the Conference of Bucharest, maturity of faith in Christ expressed in responsible parenthood, and social conditions of responsible parenthood in Peruvian squatter settlements. The 3 articles on philosophical and theological aspects concern conceptual foundations of neomalthusian theory, pastoral attitudes in relation to responsible parenthood, and pastoral action regarding responsible parenthood. 2 articles on psychophysiological aspects discuss the couple and methods of fertility regulation and the gynecologist as an advisor on psychosexual problems of reproduction. Educational aspects are discussed in 3 articles on sexual pathology and education, education for responsible parenthood, and the Misereor-Carvajal Program of Family Action in Cali, Colombia. The conclusions are the result of an interdisciplinary effort to synthesize the major points of discussion and agreements on principles and actions arrived at in each of the 4 areas.
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  8. 8

    Nature's contraceptive.

    Shah I; Khanna J

    WORLD HEALTH. 1987 Nov; 10-2.

    Breastfeeding is at times referred to as "nature's contraceptive." Intensive breastfeeding naturally stops the discharge of eggs from the ovaries, which commonly is experienced as a delay in the return of menses after the birth of a baby. An obvious limitation is that for breastfeeding to produce a contraceptive effect, a successful pregnancy and suckling are essential, and it is not possible to predict when the contraceptive protection might cease. Consequently, in terms of fertility regulation, breastfeeding is regarded as a birth spacing rather than as a contraceptive method per se. The sooner a woman starts to menstruate after a birth, the shorter the birth interval is likely to be, assuming the woman is sexually active, there are no miscarriages, and no contraceptives are used. In women who do not breastfeed, the menses usually returns within 2-3 months after delivery. For those who breastfeed intensively for 1 or 2 years, the menses generally return within 6-10 months or 15-18 months, respectively. The ideal way of prolonging the birth interval seems to be by combining prolonged breastfeeding with the commencement of contraceptive use at the appropriate time, provided this time were known. Without breastfeeding and contraceptive use, the birth interval averages 16 months, but with prolonged and intensive breastfeeding it potentially could be extended by another 18 months, giving an average interval of 34 months. This suggests that the fertility of women who do not breastfeed could be halved by breastfeeding alone. The tendency for fertility to increase during the early stages of modernization is observed in countries where the trend away from a traditional of prolonged breastfeeding is not accompanied by increased use of modern contraceptive methods. It is known widely that breastfeeding helps to postpone the next pregnancy, practices and beliefs vary by region and ethnic group. For a long time, the World Health Organization Special Program of Research, Development and Research Training in Human Reproduction has been involved in the study of natural methods of fertility regulation, and it is important that WHO continues to study breastfeeding in different ethnic and social group if it intends to give sound advice on this issue to family planning programs.
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  9. 9

    Ovulation method satisfaction is relative to abstinence required.

    Burger HG; Pinol AP; Farley TM; Van Look PF


    To determine whether the degree of satisfaction experienced by a couple in the practice of the Ovulation (or rhythm) Method of natural family planning was related to the required duration of sexual abstinence, data from the 13-cycle effectiveness phase of a WHO study involving 725 women subjects in 5 countries (New Zealand, India, Ireland, the Philippines, and El Salvador) was analyzed. For both subjects and partners the length of the fertile phase was significantly longer in those expressing poor satisfaction than for those in whom satisfaction was classified as good, very good, or excellent. A similar correlation existed between the number of days of abstinence and satisfaction, whereas the total duration of the infertile phase was less strongly related to the degree of satisfaction. Length of fertile phase is the most significant determinant of the degree of satisfaction.
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  10. 10

    Fertility awareness methods. Report on a WHO workshop, Jablonna, Poland, 26-29 August 1986.

    World Health Organization [WHO]. Regional Office for Europe

    Copenhagen, Denmark, WHO Regional Office for Europe, 1987. 58 p. (ICP/MCH 518; RM/79/P05 (UNFPA); EUR/HRA target 15)

    A teachers' training workshop on natural methods of family planning in a nonreligious context was convened by the Regional Office for Europe of the World Health Organization (WHO) in August 1986 anttended by participants from 14 countries. This was the first WHO European Region workshop on natural family planning, which is increasingly accepted as a positive, effective means of controlling fertility. The workshop was organized to create a greater awareness of the natural methods of family planning as an appropriate health technology that can be used to identify the fertile phase of the menstrual cycle to aid couples in avoiding or achieving pregnancy and as the basis of education about fertility. A major recommendation of this workshop was that the term "natural family planning" should be replaced with the term "fertility awareness methods" in order to correct the implication that other contraceptive methods are unnatural and bad. To suit the variety of individual needs and preferences, family planning professionals should offer fertility awareness methods as one option in an extensive repetoire of possibilities. The cervical mucus or cervical palpation methods are more appropriate for postpartum or premenopausal women than the basal body temperature method, since the latter is not very effective when ovulation is irregular. Fertility awareness should also be promoted as a back-up when other contraceptive methods are not available and as a means to help infertile couples achieve pregnancy. The teaching of fertility awareness methods in a nonreligious context should address other forms of sexual activity and the possibility of using barrier methods on fertile days. The teaching of fertility awareness should be integrated into all health and education curricula aimed at youth and adults, professionals and nonprofessionals. Since these methods require cooperation on the couple's part, a special curriculum should be designed for men.
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  11. 11

    Is it o.k. for PPFA to say "no way"?

    Newcomer S

    New York, New York, Planned Parenthood Federation of America, 1986. 5 p.

    The Planned Parenthood Federation of America's (PPFA) best-selling pamphlet has been the one that tells teens how to say no to sex, but teens uniformly find it preachy and patronizing. Adults like the pamphlet, but teenagers are still having sex. US adults have difficulty in deciding whether it is best for teenagers to not have babies, not get pregnant, or not have intercourse. About half of US teens have had intercourse by the age of 18, and about half have not. The current political climate indicates that PPFA should promote abstinence. However, sexual behaviore is not rare. Abstinence from intercourse is an important component of human sexuality. Being able to say no to intercourse without being hurtful to oneself or others is a valuable skill, but PPFA should teach such skills within the context of sexuality education not instead of it. Teaching only abstinence may keep teens away from PPFA clinics, instead of bringing them in. What PPFA can and should do is to help schools, school systems, and states implement the provision of sexuality education for all students, and to work to assure that contraceptive services are accessible to young people.
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  12. 12

    Breastfeeding effects on birth interval components: a prospective child health study in Gaza.

    Anderson JE; Becker S; Guinena AH; McCarthy BJ

    Studies in Family Planning. 1986 May-Jun; 17(3):153-60.

    Data from a prospective child health study conducted in Gaza by the WHO was used to examine the relationship between infant feeding and subsequent fertility. The study group consisted of 769 women living in 2 refugee camps in Gaza who gave birth in a 2-month period in 1978, and their index children, followed up for 23 months with monthly visits. Women who became pregnant within the 23 months were followed up until the end of their pregnancy. Women who practiced contraception after the birth of the index child were excluded. Life table analyses demonstrate a strong relationship between breastfeeding and 2 components of birth intervals, the postpartum anovulatory period and the waiting time from the end of the anovulatory period to conception. Duration of breastfeeding in this population averaged 12 months. Once menses have resumed, main factors related to waiting time to conception are age, husbands education, and measures of breastfeeding intensity and duration. Women who are breastfeeding when menstruation resumes and continue to do so are less likely to conceive than other women.
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  13. 13

    Thirteenth annual report.

    World Health Organization [WHO]. Special Programme of Research, Development and Research Training in Human Reproduction

    Geneva, WHO, 1984 Dec. ix, 152 p.

    88 recommendations were formulated by the International Conference on Population held in Mexico City in 1984. 4 of these dealt specifically with research requirements in the population field and are reproduced in this report in their entirety. As a result of the changing perspectives and requirements of the scientific fields in which the Special Program of Research, Development and Research Training in Human Reproduction operates and taking into account the various suggestions resulting from recent reviews of the Program, several new developments have occurred. First is the attempt to distinguish more clearly between activities related to research and development and those related to resources for research. These 2 distinct but closely connected activities will be reorganized to interact in a complementary fashion. In the research and development component, the most notable changes relate to the creation of new Task Forces on the Safety and Efficacy of Fertility Regulating Methods and on Behavioral and Social Determinants of Fertility Regulation. The Program has been actively promoting coordination with other programs which support and conduct research in human reproduction. The research and development section of this report provides a technical review of the activities and plans of the various task forces, covering the following: new and improved methods of fertility regulation (long-acting systemic methods, oral contraceptives, post-ovulatory methods, IUDs, vaccines, plants, male methods, female sterilization, and natural methods), safety and efficacy of fertility regulating methods, infertility, and service and psychosocial research. The section devoted to resources for research describes some features of the network of centers, reviews the Program's institution strengthening activities in the different regions, and also considers research training and the program of standardization and quality control of laboratory procedures. The section covering special issues in drug development focuses on relations with industry, patents, and the role of the Special Program in the drug regulatory process.
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  14. 14

    The Billings method of family planning: an assessment.

    Betts K

    Studies in Family Planning. 1984 Nov-Dec; 15(6/1):253-66.

    This paper critically analyzes claims for the effectiveness of the Billings method of natural family planning and raises questions about the wisdom of actively promoting this method. The Billings method, developed in Australia, is based on client interpretation of changing patterns of cervical mucus secretion. Evaluation of the method's use-effectiveness has been hindered by its supporters' insistence on distinguishing between method and user failures and by the unreliability of data on sexual activities. However, the findings in 5 large studies aimed at investigating the biological basis of the Billings method provide little support for the claims that most fertile women always experience mucus symptoms, that these symptoms precede ovulation by at least 5 days, and that a peak symptom coincides with the day of ovulation. Although many women do experience a changing pattern of mucus symptoms, these changes do not mark the fertile period with sufficient reliability to form the basis for a fully effective method of fertility control. In addition, the results of 5 major field trials indicate that the Billings method has a biological failure rate even higher than the symptothermal method. Pearl pregnancy rates ranged from 22.2-37.2/100 woman-years, and high discontinuation rates in both developed and developing countries were found. Demand for the method was low even in developing countries where calendar rhythm and withdrawal are relatively popular methods of fertility control, suggesting that women of low socioeconomic status may prefer a method that does not require demanding interaction with service providers and acknowledgment of sexual activity. The Billings method is labor-intensive, requiring repeated client contact over an extended time period and high administrative costs, even when teachers are volunteers. It is concluded that although natural family planning methods may make a useful contribution where more effective methods are unavailable or unacceptable, many of the claims made for the Billings method are unsubstantiated by scientific evidence.
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  15. 15

    Report of the meeting of experts in natural family planning, Task Force on Methods for the Determination of the Fertile Period, Geneva, 9-11 February 1976.

    World Health Organization [WHO]. Special Programme of Research, Development and Research Training in Human Reproduction

    [Unpublished] 1976. 17 p.

    As a result of the meeting of experts in natural family planning (NFP) methods, recommendations were made for research. To select priorities for types or research needed, the following criteria were used as a guide: relevance (with respect to the practice of NFP), feasibility (state of knowledge and availability of methodology and manpower), time, and cost. Very specific recommendations were presented by each of the conference participants. Using the delphi method of ranking priorities, the following recommendations were ranked as the most important research areas: 1) factors that effect choice, demand, and use of NFP include social, educational, psychological, cultural, service aspects and studies on continuation of use in couples who start NFP versus couples who switch to NFP; 2) the need to assess the psychosocial integrative or disintegrative effects of fertility regulation methods,including the impact of fertility regulating methods on conjugal stability, and the psychological significance of the act of coitus in different peoples and culture; 3) service aspects of the educational component of NFP, including value of mass educational techniques, nonmedical settings, content of programs, teaching methods, promotion and reinforcement of abstinence, and intensity of emphasis given the male partner; 4) determine the temporal relatiohships between basal body temperature, abdominal pain, mucus, and events in the hormonal profile; and 5) clinical trials of NFP in the postpartum, postpill, lactating, and premenopausal period. Throughout the conference a number of general issues were raised, the most frequent being the need for a universal definition of NFP and misunderstanding of use of some NFP methods, discrepancies in reporting use-effectiveness of NFP, and errors in overall interpretation of data accumulated on NFP methods.
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  16. 16

    WHO: natural methods "relatively ineffective".

    International Family Planning Perspectives and Digest. 1978 Winter; 4(4):125-6.

    Carefully controlled studies conducted by the World Health Organization (WHO) found 2 of the most modern natural family planning (NFP) methods--the ovulation and the symptothermal methods--to be "relatively ineffective for preventing pregnancy." The 2 methods were compared in a randomized study in Colombia and the ovulation method alone was evaluated in 5 countries. Centers with natural family planning experience were selected and only motivated volunteers were recruited, all of whom were given personal instruction, yet in Colombia 16-22% of the women became pregnant within the 1st year of use. In 5 countries 19 pregnancies/100 woman years occurred. A problem with rhythm methods may be the lack of knowledge of the events surrounding conception, the report notes. In 1976, a comparative study of the ovulation and symptothermal methods of NFP was begun under WHO auspices. Women were admitted to the study after they agreed to be randomly allocated to 1 of the methods. All were aged 18-39 and had a history of regular menstrual cycles. They were given 3-5 months of training. Before entering the effectiveness phase of the study, the volunteers were required to have practiced the method correctly during the last 2 months of training. As of August 1978, there were 439 couples in the study. During the 1st year of participation in the study, life table analysis showed that 16% of couples using the symptothermal method and 22% of those using the ovulation method had unwanted pregnancies. In El Salvador, India, Ireland, New Zealand, and the Philippines, centers with experience with the ovulation method and with qualified teachers available participated in the WHO study, which began in 1975. As of October 1978, 890 women had contributed 2685 cycles to the study; 40 women had become pregnant, i.e., 19.4 pregnancies/100 woman years of use. According to WHO, the high rate of failure was not due to the inability of the women to learn the method but to couples "taking a chance" during the fertile phase. 1 reason for the method failures of periodic abstinence may be that the life span of sperm in the female reproductive tract may be longer than was previously believed. WHO is continuing to develop teaching and educational materials for the ovulation and symptothermal methods in the hope that they might help reduce user failure with these methods.
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  17. 17

    Breast feeding: fertility and contraception.

    Kleinman RL; Senanayake P

    London, International Planned Parenthood Federation, 1984. 43 p. (IPPF Medical Publications)

    This booklet, for health care workers in developing countries, reviews the fertility-controlling effects of breastfeeding, its strengths and limitations as an element in family planning, and how to provide modern methods of contraception to lactating women. Breastfeeding currently provides about 30% more protection against pregnancy in developing countries than all of the organized family planning programs. The recent trend toward a falling off in the practice of breastfeeding poses a threat to infant welfare and a danger of increased fertility. Health workers are urged to reach pregnant women in the community with knowledge about the value of breastfeeding versus bottle feeding. Each country must set its own policies concerning contraception for lactating women. It is preferable for lactating women to use nonhormonal methods, but if selected, they should not be used too early. Lowest-dose preparations, especially progestogen-only pills, are preferable. Determination of when to start contraception during lactation should be based on breastfeeding patterns in the community, the age at which supplementary foods are introduced, usual birth spacing intervals, and the mean duration of lactation amenorrhea. If the usual time of resumption of menstruation in a given community is known, a rough guide to the optimal time for starting contraception is returning menstruation minus 2 months.
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  18. 18

    Report on the family fertility education learning package.

    Sketchley J; Hewertson R

    London, England, British Life Assurance Trust for Health and Medical Education, 1981 Jul. 140 p. (WHO Project No. 77908)

    The Family Fertility Education Learning Package (LP) is a collection of teaching and learning materials on natural family planning (NFP) produced by the British Life Assurance Trust for Health Education at the request of the World Health Organization (WHO). The LP is intended to form the core of a standardized curriculum for instructing NFP teachers and user-couples in ovulation and sympto-thermal methods of NFP. The LP consists of an educational handbook, compendium of goals and objectives, glossary, and 4 modules (fertility awareness, sexuality and responsibility, ovulation method, and sympto-thermal method) and 4 corresponding sets of visual aids. Field trials included selection of test countries and allocation of methods to those sites; selection and training of principal personnel, trainee teachers, and user-couples; and evaluation procedures. Test countries were Canada, Colombia, Kenya, Korea, Philippines, and the UK. 200 trainee teachers were initially recruited, 86 of whom discontinued. 512 new users were recruited, largely through personal contact with a teacher trainee, for the sympto-thermal method and 378 for the ovulation method; 135 in the former group and 46 in the latter group discontinued. Data were collected to evaluate the effectiveness, efficiency, and acceptability of the LP and to determine the extent to which it is feasible to produce a LP which can be used in any culture or environment. 5 conclusions were drawn regarding the project itself: 1) selection criteria for teachers and users were too strict, 2) training of principal personnel was incomplete, 3) the key figures in the evaluation of the project did not remain constant, 4) lack of money impeded implementation of principles of educational methodology, and 5) there was no training in recruitment techniques. 32 specific recommendations are made for expanding, clarifying, and re-formatting the LP. However, no major modifications of the LP are suggested. Users reported they acquired sufficient knowledge, skills, and attitudes from the LP to use NFP methods. The flexibility and adaptability of the LP were cited by teacher trainees. Although most centers supplemented the LP with their own materials, no country replaced a substantial part of the LP or taught NFP in a method discordant with the aims of the LP.
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  19. 19

    [The Billings method] El metodo de Billings.

    Temas de Poblacion. 1981 May; 7(12):14.

    The World Health Organization (WHO) has financed a study of the Billings method of family planning in 3 developing and 2 developed countries to obtain objective data on the effectiveness of the method. Although 40% of the 870 couples had previously used another abstinence method and all were highly motivated to use the technique, the life-table pregnancy rate for the year following training in the method reached 20%. 11 studies of the cervical mucus method have been carried out in India, Tonga, Colombia, and Chile and in the US and Australia, often in new programs which did not employ uniform teaching methods. 2 Indian studies showed pregnancy rates of under 6/100 woman years, while 2 studies in developed countries showed rates under 15 and 2 showed rates over 30/100 woman years. Most of the studies have attributed the high pregnancy rates to the failure of couples to observe abstinence. Pregnancy occurred in the 5 countries partcipating in the WHO studies primarily as a result of the failure of couples to abstain from sexual relations during periods identified as fertile, despite active promotion of natural family planning and assistance from instructors at monthly intervals. Other reasons for the high failure rate were late occurrance of mucus flow relative to the time of ovulation, overly early appearance of mucus, and failure to observe or to interpret correctly the mucus symptom. Mucus patterns and facility of interpretation can be affected by various physiological or psychological factors, such as vaginal or cervical infection, vaginal secretion due to sexual stimulation, medicines, tension, and illness. The common observation of higher pregnancy rates among couples who wish to postpone rather than prevent a birth appears to be particularly important in the case of abstinence methods.
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  20. 20

    WHO and research in natural family planning.

    Lanctot CA

    Linacre Quarterly. 1978 Nov; 45(4):395-404.

    The World Health Organization (WHO) Special Program of Research, Development and Research Training in Human Reproduction, established in 1972, deals with all aspects of research in human reproduction, but the emphasis of the program is on the regulation of fertility. Focus in this discussion is on the work of the Task Force on Methods for the Determination of the Fertile Period. Research in this task force aims at the following: assessing in different countries and cultures the currently available methods based on periodic abstinence; improving the service delivery of these methods; evaluating physiological parameters which determine the duration of the fertile period; and developing assay kits and devices for predicting and detecting the time of ovulation. The appeal of methods based on periodic abstinence would possibly increase if techniques were developed to permit women to determine objectively and precisely the fertile and infertile phases of the menstrual cycle. Basically there are 4 main methods of fertility regulation based on periodic abstinence: the calendar method (rhythm); the temperature method (BBT); cervical mucus methods (CM), e.g., the ovulation method (OM); and sympto-thermal method(s) (S-TM). In August 1976 subject recruitment began for a multicenter clinical evaluation of the ovulation method (Billings). The steering committee, impressed by the low method failure rate of this study, recommended that an interstudy comparison and analysis of all pregnancies and dropouts be undertaken to better delineate this phenomenon. The educational component of methods based on periodic abstinence plays a more important role than in other family planning methods. The major emphasis of the work of the task force in this area is to develop, field test, and evaluate educational materials which would form the core of a standardized curriculum for instructing natural family planning (NFP) non-physician teachers. The methodology for the development of the NFP Learning Package, called the "Family Fertility Education Learning Package," was designed in December 1975. Efforts in the areas of the evaluation of physiological events relating to the period, assay kit development, and device development are also reviewed. The work of the task force requires the participation of scientists from a variety of disciplines.
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  21. 21

    Family fertility education learning package: WHO Project 77908.

    Clarke WD

    [Unpublished] 1980. Presented at the 2nd International Conference of the International Federation of Family Life Promotion, Navan, Ireland, September 24-October 1, 1980. 21 p.

    Focus in this discussion is on improving the service delivery of natural family planning (NFP) methods. In response to requests from several family planning organizations interested in methods based on periodic abstinence, the World Health Organization (WHO) became involved in evaluating and improving the educational aspects of these methods. The educational component of such methods was viewed from the start as playing a more important role than in other family planning methods. The Task Force identified its purpose in the improvement of service delivery of NFP methods as the development, field testing, and evaluation of educational materials (the FFELP), which would form the core of a standardized curriculum for instructing NFP teachers and user-couples in the use of the ovulation method and the sympto-thermal method. The intention was that the educational materials developed would be for use by nonphysicians ranging from nurses to lay members of the community who are interested in becoming NFP instructors. In December 1975 a consultation of NFP teaching experts and staff members of the WHO Human Reproduction Unit and the Educational Communication Systems Unit took place in Geneva. Their purpose was to plan the development of the learning package. The Learning Package consisted of a guide to teaching, or educational handbook, and four NFP method manuals (fertility awareness, sexuality and responsibility, ovulation method, and sympto-thermal method) each with its own visual aids and progress monitors as well as a glossary and a compendium of goals and objectives. The campaign plan is reviewed. It included the following: organization of the project; selection of test countries and sites and allocation of methods to those sites; selection and training of personnel, trainee teachers, and user couples; evaluation procedures; and site visits by the project director. A description of the learning package is included.
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  22. 22

    IFFLP African NFP Instructor Project 1978-1980: progress report no. 1.

    International Federation for Family Life Promotion [IFFLP]

    Washington, D.C., IFFLP, 1979 Mar. 75 p.

    This report presents an overview of the first 8 months of activity of the IFFLP: African NFP Instruction Project, which aims to institutionalize natural family planning educational technology in several African countries through a plan consisting of the following stages: 1) implantation (June 1978-December 1980), which aims to reach as many African countries as possible, and to perceive and initiate interest in natural family planning educational technology; 2) demonstration (1980-1985) which will allow for selected African countries to set up demonstration programs and integrate natural family planning educational seminars into their existing health, education, welfare or other community development systems; and 3) expansion and development (1985-1995) which will enable African countries with successful demonstration programs and with interested national governments or nongovernment organizations to pursue natural family planning expansion. The report also describes, analyzes, and evaluates 3 major programs: 1) the participation of 4 IFFLP delegates in the Abidjan 11th CICIAMS World Congress; 2) the first English tour (July-August 1978); and 3) the first French tour (November-December 1978). Description of these 3 programs are complemented by country profiles on Liberia; Sierra Leone; Zaire; People's Republic of the Congo; Ivory Coast; Upper Volta; Senegal; Morocco. Administrative aspects and revised budget of the project are also discussed. Also included in the report are NFP training manuals; presentation summary of African Project (1978); more specific local funding guidelines; and few scenes from the first French tour.
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  23. 23

    NFP internationally: an overview.

    Lanctot CA

    In: Ireland. Dept. of Health, World Health Organization [WHO]. International Seminar on Natural Methods of Family Planning, Dun Laoghaire, County Dublin, Ireland, October 8-9, 1979. [Dublin, Ireland, Dept. of Health, 1979]. 166-76.

    This paper summarizes the international development of National Family Planning (NFP) over the last 25 years in view of: 1) recent developments, 2) status of NFP in various countries, 3) popularity of NFP in terms of use, effectiveness, and acceptibility, and 4) the potential of NFP. 3 phases are outlined: 1) Clinical phase before 1955 when basic discoveries in reproductive physiology were achieved, the rhythm method was popularized, and experiments for measuring basal body temperature (BBT) were developed; 2) pioneer phase (1955-70) when NFP centers developed empirical tests of monitoring techniques, the Billings or ovulation method (OM) was developed, and sympto-thermal methods became popular; 3) popularization phase (1970-present) when NFP methods were popularized. Current research includes clinical trials for effectiveness, education, NFP instruction, and basic research into operating procedures and psychosocial factors of NFP. Major programs include the World Organization of the Ovulation Method by Billings (WOOMB), a program devoted to OM methods of NFP, and the International Federation for Family Life Promotion (IFFLP), a program devoted to the development of natural associations of NFP interests. IFFLP now has members in over 70 countries (in Africa, Asia, Australia, North America, Central and South America, and Europe). IFFLP devotes itself to knowledge or technology transfer projects in centers which hold workshops and work towards developing national organizations worldwide. 80-90% of the NFP programs are Catholic inspired although more than 50% of the users of NFP are non-Catholic. The popularity of NFP has been limited, if not declining, in some countries, although 50% of the family planning population in Japan practice the Ogino method of NFP. This is because of the advances in other contraceptive devices and the limits of NFP in terms of effectiveness and perceptions about the method. Recent developments in NFP suggest that: 1) effectiveness is 1-5 conceptions/100 women, 2) education and instruction may reduce the risk, 3) side effects of other contraceptive techniques are increasingly found to be damaging, and 4) behavioral insights into NFP is increasing because of ecological, health, and other concerns. The potential of NFP programs is compared to the natural childbirth movement in maternity care. Development of the potential is related to education, instruction, and perceptions about the value of NFP. Measures need to be taken to develop culturally appropriate out-reach programs, quality standards for NFP teachers, standardized service records, follow-up guidelines, health referrals, and administrative frameworks.
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  24. 24

    Research on natural family planning: the WHO Task Force on Methods for the Determination of the Fertile Period.

    Spieler J

    In: Ireland. Dept. of Health, World Health Organization [WHO]. International Seminar on Natural Methods of Family Planning, Dun Laoghaire, County Dublin, Ireland, October 8-9, 1979. [Dublin, Ireland, Dept. of Health, 1979]. 146-53.

    The WHO (World Health Organization) Task Force on Methods for the Determination of the Fertile Period addresses itself to the following topics: 1) the effectiveness of natural family planning (NFP) methods; 2) ways of improving NFP technology and developing new methods for predicting and detecting ovulation and the fertile period; 3) improving the delivery of NFP, particularly by nonphysicians, and 4) the psychosocial and psychosexual aspects of NFP. The WHO Programme is interested in NFP research for the following reasons: 1) political (to pacify such vocal groups as the Vatican, pro-life organizations, ecology-minded people); 2) to obtain objective information on NFP's effectiveness, continuation of use, advantages and disadvantages and limitations since these methods are being promoted and used; 3) the need and a place for non-chemical, non-device, non-invasive and reversible methods within the technology for fertility regulation; and 4) no other intergovernmental or international organization is undertaking research on NFP in developing countries. The research officially began to function in 1974, and the research scope included the prediction, as well as the detection of ovulation, and the determination of the start and end of the fertile period. The problems associated with NFP include accurate identification of the fertile days of the menstrual cycle, the number of days of abstinence required, and the implementation of abstinence if pregnancy is not desired, and the need for daily continued motivation and cooperation of both partners. Studies by the Task Force included those which obtained data on the percentage and characteristics of couples who can and cannot successfully learn and use the methods; reasons for discontinuation; difficulties experienced in recordkeeping; motivation for using NFP and others. Some of the studies show that the effectiveness of the method is affected almost exclusively by the motivation of the couple. The Task Force also aims to develop inexpensive and easy-to-use technology suitable for home use, primarily in developing countries. Further research is being done on 1) factors that affect demand, choice and use of NFP methods; and 2) the psychosociological integrative and disintegrative effects of fertility control methods including their impact on conjugal stability and the psychological significance of the act of coitus in different peoples and cultures.
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  25. 25

    The WHO Family Fertility Education Learning Package.

    Clarke WD

    In: Ireland. Dept. of Health, World Health Organization [WHO]. International Seminar on Natural Methods of Family Planning, Dun Laoghaire, County Dublin, Ireland, October 8-9, 1979. [Dublin, Ireland, Dept. of Health, 1979]. 110-4.

    The WHO Family Fertility Education Learning Package aims to establish a minimum set of learning objectives to teach and learn NFP (natural family planning). It consists of modules such as "Fertility Awareness" which deals with the physiological and anatomical basis of NFP and "Sexuality and Responsibility" which deals with its psychosexual aspects. The learning package was limited to modules on the ovulation and symptothermal methods, with the latter incorporating the teaching of basal body temperature in a format that enabled it to be used separately if so desired. Each teacher was provided a copy of the objectives, a glossary of terms used and an educational handbook. The learning package is being tested in 6 sites chosen by WHO: Canada, Colombia, Kenya, Korea, the Philippines, and the United Kingdom. A Principal Investigator, a Principal Teacher, and a Principal Evaluator were appointed for each site. Stage 1 of the project, the training of teachers, has been completed and a report should be available next year. Stage 2, the training of new users by new teachers should be completed and a report available by mid 1980. Selection criteria for learners and users of NFP include: 1) married/stable union; 2) aged 18-39; 3) history of normal ovulatory cycles of 23-40 days; 4) good health; 5) committed to using the method for at least 6 months to avoid pregnancy; 6) be able to accept an unplanned pregnancy should it occur; 7) husband and partner willing to cooperate in the study. Selection criteria for teachers include; 1) married/stable union couple or single female; 2) history of normal ovulatory cycles of 23-40 days; 3) good health; 4) literate and capable of achieving set objectives; 5) no previous NFP teaching experience; 6) not using any method other than NFPs; 7) experience of 3 months charting; and 8) commitment to project for 18 months. The project will be evaluated to 1) assess the efficiency and effectiveness of the learning package; 2) identify methods of use; problems and shortcomings; efficiency and effectiveness factors; successful and unsuccessful aspects; 3) describe the contents of the study and ways it is used; and 4) to provide a basis for informed judgments regarding revisions. Methods of evaluation are briefly discussed.
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